Some babies will end up with their heads a bit misshapen. Why does it happen, should you worry about it, and what can you do?
Let’s start with some definitions.
We give a misshapen head different names depending on the way you baby’s head shape has changed.
Brachycephaly
When a baby’s head is very flat at the back.
Scaphocephaly
A baby’s head can also appear flattened from side to side. This is referred to as scaphocephaly. I’ve included a picture so you can see what I mean.
Plagiocephaly
The most common change is when there is a difference from one side to the other of the baby’s head. This is called plagiocephaly.
It’s also pretty common, however, for the term plagiocephaly to be used as a catch-all term for all kinds of misshapen heads.
Plagiocephaly is usually divided into two types:
Congenital or craniosynostotic plagiocephaly
Developmental or positional plagiocephaly
Congenital plagiocephaly
Congenital plagiocephaly is where some of the bones of the skull fuse early. Look, this is rare. It really doesn’t happen that often. It is, however, the more serious of the two. If I see a baby in whom I suspect congenital plagiocephaly I will refer them to be assessed properly by a paediatrician. When it occurs, the typical treatment is surgery, which from what I understand is usually pretty successful.
Developmental plagiocephaly
Developmental plagiocephaly is much more common. This can occur in up to 50% of babies. Here, there is no fusion of the bones in the skull, they are just sitting unevenly. This kind of misshapen head usually starts to become obvious at around 6 weeks of age, give or take a bit. You can rarely see it before this.
There’s a bunch of reasons this can happen. Essentially it’s called “positional” because common thought is that it is caused by a sustained posture that is lopsided in some way. For example, perhaps your baby always turns his head to one side, either when sleeping or playing. Or maybe your baby lies with a bend down her back, like a banana. The current thinking is that lying asymmetrically, for example with the head predominantly turned to one side, increases the pressure on the back of the head on that side, so it starts to flatten out. These asymmetrical postures can happen because of the position the baby was in while in the womb. They can also occur if there was strong pulling on the neck or spine during birth, such as might happen if forceps or vacuum extraction was necessary. There has also been an increase in deformational plagiocephaly since we started sleeping babies exclusively on their backs because of SIDS. (Now, please, this does NOT mean you should stop sleeping babies on their backs. There are other things we can do to counteract the effects of back sleeping.)
Okay, so why do we care about flat head syndrome? Well, if you look at a lot of sources of information about plagiocephaly they say that it’s a purely “cosmetic” condition. In other words, the only issue is the appearance of the baby. But there is a body of evidence that shows an association between positional plagiocephaly and delays in development. The most obvious delays are seen in the development of language and gross motor skills. Some studies have seen these delays last into early school age.
Now, let’s pause, because saying that there is a link between flat head syndrome and development is a big claim, and I really don’t want to worry anyone unnecessarily. So I should acknowledge that while there is an association, we don’t know if the plagiocephaly causes the developmental delay. Maybe it’s the other way around. Or maybe there’s something else going on that we haven’t discovered yet. We also can’t yet say with any certainty that correcting positional plagiocephaly improves any developmental delay. We really need more information to be able to understand the association better, and those studies haven’t been done yet. I do feel some concern, however, that plagiocephaly is still presented as a purely cosmetic issue, because if there is a chance that it has some bearing on development, isn’t it better that parents have the opportunity to get it dealt with early if they choose?
Treatment of developmental plagiocephaly
On that note, let’s talk about treatment options. There is a lot you can do to address developmental plagiocephaly. When developmental plagiocephaly is treated, the misshapen head might be addressed, or the underlying uneven posture may be treated. I think it’s important to deal with both. This is partly because there are studies that suggest that babies with an uneven posture will also have some other functional issues. And that means that an approach to treatment that looks at more than just the uneven head seems to be a good idea.
The treatments most commonly available:
Home care to encourage more symmetrical postures (what you can do at home)
Manual therapy:
Physiotherapy can address uneven postures
Chiropractors and osteopaths trained in paediatrics and who perform cranial therapy
Helmet therapy to correct misshapen heads
Home care of developmental plagiocephaly
Let’s talk about home care first. There are a few things you can do at home.
One of the best is giving your baby regular tummy time. This can be done from birth. Tummy time stimulates the muscles in the neck and spine, as well as helping to develop the strength to hold oneself upright. It can help to correct any asymmetrical postures.
Vary your baby’s sleeping posture. Try putting them up the other end of the cot, or move the cot around the room so that light and interesting objects in their field of vision change position.
If your baby has a tendency to turn to one side more than the other, then you can place interesting objects around them to encourage them to turn to the opposite side. High contrast, colourful objects or pictures, or toys that make an interesting sound can be good. Remember, the recommendations are to place nothing in the cot or bassinet with your baby while they sleep.
Some authorities suggest the use of special pillows in the cot to encourage the baby to keep their head centred, and to reduce the pressure on the back of the skull so that it is less likely to flatten. There is some evidence to support their use, and other evidence that suggests they don’t really help. If you are thinking of using one, get some advice from a health professional first.
Physiotherapy for developmental plagiocephaly
Next, physiotherapy. A good paediatric physiotherapist will be able to assess and treat postural and functional asymmetries, which can consequently make a difference to the progress of plagiocephaly.
Chiropractic and osteopathic care for developmental plagiocephaly
Okay, now to chiropractic and osteopathic care. A practitioner who is trained to work with babies, and who performs cranial therapy, should be able to work with any uneven posture in the same way as a physiotherapist can, and will also be able to address the skull itself. Paediatric chiropractic and osteopathy has a great safety record, and is typically very gentle, such that it may seem to parents watching treatment that not much is being done.
Helmet therapy for developmental plagiocephaly
Finally, helmet therapy. This has a reputation for being effective, but it can mean having the baby in a helmet for a considerable length of time. I would tend to recommend this as a last resort, if other treatments haven’t been effective.
Summary of plagiocephaly or flat head syndrome
The most common kind of plagiocephaly results from your baby lying in an uneven posture.
There may be some links between plagiocephaly and developmental delays.
Flat head syndrome is generally treatable, using a combination of home care and manual therapy.
There are other options like helmet therapy if needed, too.
Can a chiropractor help your baby with plagiocephaly?
We’re here to help and answer your questions. Contact us or book an appointment at our clinic in Canberra.
Plagiocephaly references
Fowler EA et al, Neurologic findings run infants with deformational plagiocephaly. J Child neural 2008;23:742
Speltz ML et al, Case-control study of neurodevelopment in deformational plagiocephaly. Pediatrics 2010;125(3):e537-e542
Kordestani RK et al, Neurodevelopmental delays in children with deformational plagiocephaly. Plas Recon Surgery 2006;117(1):207-218
Hussein MA, Woo T, Yun IS, Park H, Kim YO, Analysis of the correlation between deformational plagiocephaly and neurodevelopmental delay. Journal of Plastic, Reconstructive & Aesthetic Surgery 2018;71:112-117
Collett BR et al, Development at age 36 months in children with deformational plagiocephaly. Pediatrics 2013;131:e109-e115
Miller RI, Clarren SK, Long-term developmental outcomes in patients with deformational plagiocephaly. Pediatrics 200;105(2):E26
Siatkowski RM et al, Visual field defects in deformational posterior plagiocephaly. Journal of AAPOS 2005;9(3):274-278
Vlimmeren LA et al, Effect of paediatric physical therapy on deformational plagiocephaly in children with positional preference: a randomised controlled trial. Arch Pediatr Adolesc Med 2008;162(8):712-718
Gordon B, A retrospective study of the management of deformational plagiocephaly with chiropractic care. Chiropractic Journal of Australia 2015;45(2):156-174